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Mild Cognitive Impairment

Mild cognitive impairment is defined as an intermediate state between normal cognitive function and dementia. In addition to neurodegenerative diseases, vascular insults, trauma, and drugs can induce this condition. Mild cognitive decline reported by patients themselves or during history taking is the principal diagnostic criteria. Patients are distinguished from those suffering from dementia by their ability to live independently and perform daily activities without assistance or with minor assistance.


Presentation

The diagnostic criteria for mild cognitive impairment (MCI) have undergone several revisions in recent years but this clinical entity is generally known as an intermediate state between normal cognitive impairment and dementia [1] [2]. More specifically, MCI is suspected if the cognitive decline is acquired unexpectedly sooner in terms of age or educational background, but without the impairment of activities of daily living[3] [4] [5]. Patients can experience a decline in one of the five cognitive domains: language; executive functioning; psychomotor skills; learning and memory; or visuospatial abilities [1] [4]. The distinction between dementia and MCI lies in the fact that the majority of patients suffering from MCI have only one (or sometimes more than one) cognitive deficits, e.g. memory complaints, whereas dementia is usually characterized by multiple cognitive deficits [1]. Furthermore, MCI is distinguished by the preservation of functional independence and activities of daily living, although time to complete more complex tasks, such as cooking, shopping or paying bills may be increased and is often noted by patients themselves [1]. The objectivity and self-awareness of patients about their cognitive decline are also the key criteria for MCI [1] [5] [6]. This disorder most frequently arises in the setting of Alzheimer's disease and other forms of dementia (Parkinson's disease, and less commonly frontotemporal degeneration), which is why the lifetime risk for full-blown dementia is substantially increased in this patient population [3] [4]. However, cerebrovascular diseases, traumatic brain injury, depression and multiple comorbidities have also been implicated in the pathogenesis of MCI [4] [6]. In any case, prompt recognition is mandatory in order to ensure the best possible outcome.

Chronic Hypotension
  • INTRODUCTION: Midlife hypertension is associated with dementia in longitudinal studies while chronic hypotension in the elderly is associated with dementia onset. Orthostatic hypotension could influence cognitive performance in the elderly.[ncbi.nlm.nih.gov]
Orthostatic Hypotension
  • Orthostatic hypotension could influence cognitive performance in the elderly. The objective of this study was to assess the relationship between orthostatic hypotension and cognitive functions.[ncbi.nlm.nih.gov]
Localized Scleroderma
  • Neurologic involvement is well recognized in Systemic Scleroderma and increasingly reported in Localized Scleroderma. MRI brain abnormalities are often associated with symptoms such as seizures or headaches.[ncbi.nlm.nih.gov]
Memory Impairment
  • KEYWORDS: Alzheimer’s disease; Amnestic; Hyposmia; Mild cognitive impairment; Non-amnestic; Subjective memory impairment[ncbi.nlm.nih.gov]
  • All the patients with aMCI had pathologic findings involving medial temporal lobe structures, likely accounting for their memory impairment.[ncbi.nlm.nih.gov]
  • The Memory Impairment Study (MIS) is a multicenter clinical trial in patients with MCI designed to evaluate whether vitamin E or donepezil is effective at delaying the time to a clinical diagnosis of AD.[ncbi.nlm.nih.gov]
  • The case of Ms E, a 60-year-old woman with mild memory impairment and white matter lesions on magnetic resonance imaging, provides an opportunity to consider the questions that face patient, family, and clinicians when mild cognitive symptoms prompt a[ncbi.nlm.nih.gov]
  • METHODS: In this experimental study, using purposive sampling, 60 participants age 50 years and over who complained of subjective memory impairment were screened in their communities by public health volunteers with the Abbreviated Mental Test.[ncbi.nlm.nih.gov]
Confabulation
  • He had delusions and confabulations, without impairment of date and place orientation. Magnetic resonance imaging (MRI) demonstrated enlarged ventricles, sulcal widening, and brain atrophy.[ncbi.nlm.nih.gov]
Gait Apraxia
  • In the following years, the patient also developed behavioral disturbances, gait apraxia and parkinsonian symptoms. At present, she is 84 years old and is still followed-up periodically.[ncbi.nlm.nih.gov]

Workup

A meticulous patient history is the most important step in the workup for diagnosing MCI. During the interview, patients should be asked about their daily routine and whether certain activities have become more complex for them to perform. A heterogeneous anamnesis (with either family members or close friends) may provide useful clues, but the hallmark of MCI is self-reported cognitive decline, which can only be revealed during history taking and a full cognitive examination [4] [6]. It must be kept in mind that many drugs also induce cognitive impairment, which is why a recent history of drug use should be investigated [4]. To confirm MCI, several inventories can be used, one example being the 10-item functional activities questionnaire, which establishes if patients had difficulties with activities of various complexity (remembering appointments, driving, traveling, sorting out bills, cooking, etc.) [4] [7]. In addition, the mental status needs to be evaluated, either by using the Montreal Cognitive Assessment (MOCA) or the Short Test of Mental Status (STMS), which seems to be superior compared to the Mini-Mental State Examination (MMSE), one of the most widely implemented cognitive assessments [4] [8]. A complete neurological exam is an integral part of the workup in all patients in whom MCI and other neurological disorders are suspected, especially if other etiologies (e.g. cerebrovascular disease) are the cause of the symptoms. Also for this reason, imaging studies - computed tomography (CT) or magnetic resonance imaging (MRI) are mandatory during the workup.

Treponema Pallidum
  • This was confirmed by Treponema pallidum Hemagglutination Assay. After a complete course of antibiotic therapy, his memory complaints disappeared completely.[ncbi.nlm.nih.gov]

Treatment

  • The treatment response was related to baseline homocysteine levels: the rate of atrophy in participants with homocysteine 13 µmol/L was 53% lower in the active treatment group (P   0.001).[ncbi.nlm.nih.gov]
  • Treatment in the very earliest stages of AD may delay progression to AD.[ncbi.nlm.nih.gov]
  • treatment of AD or mild cognitive impairment (MCI) in numerous areas.[ncbi.nlm.nih.gov]
  • A larger left entorhinal cortex predicted more improvement in episodic memory after treatment and so did higher levels of motivation.[ncbi.nlm.nih.gov]
  • DISCUSSION: The treatment of dementia/MCI in South Korea will be studied in the real world during the pilot project. There will be no limitations on the type of treatment or the specific treatment method.[ncbi.nlm.nih.gov]

Prognosis

  • This result was, however, marked by a high degree of uncertainty, and empirical research is required into the impact of a prognosis on worrying, false-positive/negative prognosis, and stigmatization.[ncbi.nlm.nih.gov]
  • Primary care physicians are the first point of contact for most patients with these disorders and should be familiar with their diagnosis, prognosis, and management.[ncbi.nlm.nih.gov]
  • The guideline panel systematically reviewed MCI prevalence, prognosis, and treatment articles according to AAN evidence classification criteria, and based recommendations on evidence and modified Delphi consensus.[ncbi.nlm.nih.gov]
  • We discuss the case of a patient with MCI and provide an evidence-based framework for assessment, early recognition and management of MCI while addressing associated risk factors, neuropsychiatric symptoms and prognosis.[ncbi.nlm.nih.gov]
  • Discussion: Persons aware of their diagnostic label-either MCI or AD-and its prognosis report lower QOL than those unaware of these facts about themselves. These relationships are independent of the severity of cognitive impairment. The Author 2017.[ncbi.nlm.nih.gov]

Etiology

  • The etiology of mild cognitive impairment and mild dementia can often be established through the clinical examination, although imaging and other laboratory tests may also contribute.[ncbi.nlm.nih.gov]
  • It has a heterogeneous etiology and clinical course. This study aimed to examine the factors associated with the progression of MCI in different types of dementia disorders.[ncbi.nlm.nih.gov]
  • CONCLUSION: MetS was associated only with naMCI regardless of sex, which suggests etiologic differences in MCI subtypes. We also found sex differences in the relationship between naMCI risk and MetS and its components.[ncbi.nlm.nih.gov]
  • Detailed clinical examinations, including angiography and echocardiogram, revealed no overt etiology, supporting the idea that cardiac sympathetic denervation is due to underlying Lewy body disease.[ncbi.nlm.nih.gov]
  • However, to date, the number of studies comparing PD-MCI and MCI patients of other etiologies are too small.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiologic studies of selenium are lacking, however, with the exception of a recent randomized trial based on an organic selenium form.[ncbi.nlm.nih.gov]
  • Methods: Retroactive application of MCI criteria to data collected during a prospective epidemiologic study was performed.[n.neurology.org]
  • KEYWORDS: Cognitive impairment; Epidemiology; Parkinson’s disease; Prevalence[ncbi.nlm.nih.gov]
  • Roberts, MB ChB, MS, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel.: 1 507 538 0487; Fax: 1 507 284 1516; E-mail: roberts.rosebud@mayo.edu.[doi.org]
  • Author Comment This is a new version with updated bibliography and new epidemiologic information. Feedback Questions Links Before adding feedback, consider if it can be asked as a question instead, and if so then use the Question tab.[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • The new criteria emphasise that the AD pathophysiological process starts years and perhaps decades before clinical symptoms, and that biomarkers can detect amyloid β deposition and the effects of neurodegeneration in the brain.[ncbi.nlm.nih.gov]
  • Abstract Emotional enhancement effects on memory have been reported to mitigate the pathophysiology of Alzheimer's disease (AD).[ncbi.nlm.nih.gov]
  • BACKGROUND AND AIMS: Due to common pathophysiological findings of Alzheimer's disease (AD) with diabetes mellitus (DM), insulin has been suggested as a possible treatment of AD or mild cognitive impairment (MCI).[ncbi.nlm.nih.gov]
  • Hoozemans, Physiological and pathophysiological functions of cell cycle proteins in post-mitotic neurons: implications for Alzheimer’s disease, Acta Neuropathologica, 10.1007/s00401-015-1382-7, 129, 4, (511-525), (2015). Giovana S.[doi.org]
  • Implications for practice Positron emission tomography (PET) is a unique diagnostic tool, since it can assess pathophysiologic and metabolic processes before any anatomic changes have taken place.[doi.org]

Prevention

  • More focus on a precision nutrition approach is required to realize the full potential of vitamin therapy in preventing dementia and to avoid causing harm. 2017 American Society for Nutrition.[ncbi.nlm.nih.gov]
  • If replicated in longitudinal studies, these findings will offer new targets and strategies for prevention and treatment programs in people at risk for MCI and dementia. Copyright 2017 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • Key Messages Most interventions showed no evidence of benefit to delay or prevent age-related cognitive decline, MCI, and/or CATD.[effectivehealthcare.ahrq.gov]
  • Improvement in depression was related to improvement or prevention of decline in cognitive measures.[ncbi.nlm.nih.gov]
  • This modifiable characteristic makes the concept of MCI a promising target in the prevention of dementia.[psychcentral.com]

References

Article

  1. Ganguli M, Snitz BE, Saxton JA, et al. Outcomes of mild cognitive impairment depend on definition: a population study. Arch Neurol. 2011;68(6):761–767.
  2. Petersen RC, Negash S. Mild cognitive impairment: an overview. CNS Spectr. 2008;13(1):45-53.
  3. Werner P, Korczyn AD. Mild cognitive impairment: Conceptual, assessment, ethical, and social issues. Clin Interv Aging. 2008;3(3):413-420.
  4. Knopman DS, Petersen RC. Mild Cognitive Impairment and Mild Dementia: A Clinical Perspective. Mayo Clin Proc. 2014;89(10):1452-1459.
  5. Petersen RC, Caracciolo B, Brayne C, Gauthier S, Jelic V, Fratiglioni L. Mild cognitive impairment: a concept in evolution. J Intern Med. 2014;275(3):214-228.
  6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth Edition. Arlington, VA: American Psychiatric Publishing; 2013.
  7. Teng E, Becker BW, Woo E, Knopman DS, Cummings JL, Lu PH. Utility of the Functional Activities Questionnaire for Distinguishing Mild Cognitive Impairment from Very Mild Alzheimer’s Disease. Alzheimer Dis Assoc Disord. 2010;24(4):348-353.
  8. Tang-Wai DF, Knopman DS, Geda YE, et al. Comparison of the short test of mental status and the mini-mental state examination in mild cognitive impairment. Arch Neurol. 2003;60(12):1777-1781.

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Last updated: 2019-06-28 10:13